Provider Demographics
NPI:1730863259
Name:LEIB, KARLY J (RN)
Entity type:Individual
Prefix:
First Name:KARLY
Middle Name:J
Last Name:LEIB
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7590 W STRATH LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-4501
Mailing Address - Country:US
Mailing Address - Phone:425-246-1905
Mailing Address - Fax:
Practice Address - Street 1:7590 W STRATH LN
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-4501
Practice Address - Country:US
Practice Address - Phone:425-246-1905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID73522163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant